create my birth plan

Welcome to SeattleBirthNet: Create My Birth plan
Childbirth Education and Labor Support for Expectant Families

Welcome to SeattleBirthNet's interactive, evidence-based birth plan tool. You are your own best educator and
here's an opportunity to make decisions for you and your baby based on what research shows is the best option. If
you don't know why an option is listed, simply click it to read all about why it is there and find links to sources you can
go to for further information.
Why call it a birth plan when you have no way of actually planning your birth?
Birthing is a time when your body and baby work together to bring about life. It is difficult to plan exactly how that will
happen. By creating this birth plan, and clicking on the links to understand what options you have and why you might
or might not want them, you are building your own vocabulary to advocate for yourself at the hospital, and with nursing
staff and doctors. If you are planning a birth center or home birth, it will help you in the event of a transfer, which,
though unpleasant to think of, can occur smoothly with a good plan and good communication. Think of these as your
preferences and then be ready for anything by educating yourself (a doula is also a great resource in the birthing
room!).

Just follow the instructions to complete your birth plan and hit submit at the bottom. Your personal birth plan will be
emailed to you both in a word document and in the body of an email. It will never be shared with anyone.
This is your opening paragraph. It is a statement that you know what you want and you need their help in getting it.
You are letting them know that you want to make informed, educated decisions but that you trust them to help you
along the way. Modify it to make it a more personal statement of who you are!

Labor Preferences
Select as many options as you would like to by scrolling down and pressing the Ctrl button on your keyboard:

I would like to be free to walk around during labor

I would like to use the birth ball and position changes during labor

I would like to be able to eat lightly and drink to thirst throughout labor

I would like the room to be kept as quiet as possible

I prefer vaginal exams be kept to a minimum and done by the same person each time

I do not want an IV in unless I become dehydrated or it becomes medically necessary.

Monitoring Preferences
Select as many options as you would like to:

Please monitor me the minimum amount of time required by the hospital

Please use a fetoscope or Doppler to monitor me if possible

I do not want internal monitors placed unless medically necessary

Please leave the electronic fetal monitor on the whole time

Labor Augmentation/Induction Preferences
Select as many options as you would like to:

I do not wish to have the amniotic membrane ruptured artificially unless medically necessary

If my labor is at a point where rupturing the amniotic membrane will help it progress, please discuss this option with
me

I would like to use walking and position changes before I would use pitocin

Pain Medication Preferences
Select as many options as you would like to:

I know that pain medications exist, I am going to try to labor without them but will ask for them if I want them

If I need medication, I would like to have try a narcotic first (Nubain, Demerol, Stadol, or similar)

If I make it to the pushing stage without medication, I would like a local numbing anesthetic on my perineum before
crowning

I would like to labor without medication until it is safe for me to have a standard epidural

I would like to labor without medication until it is safe to have a "walking" epidural that starts at a low dose

After I receive an epidural I would like to remain in an upright, or fairly upright position in bed

After I receive an epidural I would like to let the baby "labor down" as far as possible before I push

Cesarean Preferences
Select as many options as you would like to:

I want to avoid a cesarean section. I appreciate any suggestions you have throughout labor to help me with this

I want my primary provider present before I agree to a cesarean section unless it is a medical emergency

If I do have a cesarean section I would like both my husband and doula present in the OR with me

Because research shows there is so much benefit to a distressed baby, after the birth of my baby I want the cord to stop
pulsing before it is cut

If the baby is well enough, I would like my husband to hold it next to me immediately after birth

Pushing/Episiotomy
Select as many options as you would like to:

To help avoid an episiotomy, please have mineral oil readily available and in use during pushing

To help avoid an episiotomy, please have warm cloths available and in use during pushing

Don't count for me when I am pushing, just remind me to push with the contraction

Please offer me gentle guidance during pushing about my position or effort

Delivery Preferences
Select as many options as you would like to:

I would like the option of delivering with a squat bar or on my hands and knees

I would like a mirror in the room during pushing so I can see my baby's birth

I would like the baby delivered right to my stomach

I would like my partner or doula to help with the catching of the baby

It is very important to me that the cord stop pulsing before it is clamped and cut

I would like the option of delivering with a squat bar or on my hands and knees

I would like to hold the baby for as long as possible before measurements are taken

If the baby needs to be taken to the NICU, I want dad to go with baby

I would like to see the placenta after it is delivered

We have made arrangements to donate or bank the cord blood

Breastfeeding Plans
Select as many options as you would like to:

I plan to breastfeed for three days and then bottlefeed

I would like to do the first nursing "on demand" when baby is ready (if I have not had an epidural)

I would like help with breastfeeding from nurses after delivery

I would like to meet with the hospital lactation consultant

I would not like any students or interns in my room at anytime

It is alright with me to have students or interns but please ask me frequently if it remains alright

I am fine with students and interns being present but not participating in my labor and delivery

I am fine with students and interns being present and participating in my labor and delivery

	Mom's Name: Dad's Name: Other Support Person's Name and relationship (mother, sister, doula etc): Estimated Due Date: My doctor is: Dear Nursing Staff, My husband, Dad-to-be and I carefully chose this hospital for the delivery of our baby because we were impressed with the quality of the facility and the attention and care of the staff. We are excited to be here and look forward to the healthy arrival of our baby with your support and expertise. We have created this birth plan to help you understand our preferences for labor and delivery and post-natal care. We fully understand that in certain circumstances these guidelines might not be followed, but it is our hope that you will assist us in making this the experience we desire. If you have questions or suggestions, please let us know. Thank You,

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